Adrenocortical suppression in multiply injured patients: a complication of etomidate treatment.
Open accessAbstract
Three patients admitted to the intensive care unit after multiple injury were observed to suffer episodes of adrenocortical insufficiency suggested by clinical manifestations and confirmed by appropriately low cortisol concentrations. This prompted a prospective study of pituitary-adrenocortical function in six multiply injured patients, three of whom showed evidence of adrenocortical suppression. The only factor common to the six patients with abnormally low adrenocortical function was an association between periods of adrenocortical suppression and intravenous infusion of etomidate; when the drug was stopped adrenocortical function was restored, and renewed administration of the drug caused further inhibition. Etomidate infusions lasting only six hours were found to cause low, flat responses to short tetracosactrin tests and grossly raised plasma concentrations of adrenocorticotrophic hormone, suggesting direct suppression of the adrenal cortex. Median plasma cortisol concentrations measured at 0900 were significantly lower and median plasma concentrations of adrenocorticotrophic hormone measured at 0900 were significantly higher in the three patients studied prospectively who were receiving etomidate infusions compared with the three patients who did not receive etomidate (p = 0.05).
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A single dose of etomidate affects adrenal function only within the first 24 hours of injury.
“the effect of a single dose of etomidate on adrenal function was only seen within the first 24 h of injury.”
From Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury (2012) · cites this paper as [78]
The effects of high-dose pentobarbital and propofol on adrenal function are more lasting but still reversible and dose-dependent.
“the effect of the metabolic suppressive agents high-dose pentobarbital and propofol were more lasting but still reversible and dose-dependent [74–83].”
From Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury (2012) · cites this paper as [78]
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Cites
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Research works printed but not linked: 1
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Inhibition of Adrenal Steroidogenesis by the Anesthetic Etomidate
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Acute secondary adrenal insufficiency after traumatic brain injury: a prospective study
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Adrenocortical Dysfunction Following Etomidate Induction in Emergency Department Patients
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Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury
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EFFECT OF A SINGLE BOLUS OF ETOMIDATE UPON EIGHT MAJOR CORTICOSTEROID HORMONES AND PLASMA ACTH
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The Effect of Etomidate on Adrenocortical Function in Dogs before and during Hemorrhagic Shock
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- Authors
- Fellows, I. W., Bastow, M. D., Byrne, A. J., & Allison, S. P.
- Affiliations
- Queen's Medical Centre (GB)
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1983-12-17
- Volume
- 287
- Issue
- 6408
- Pages
- 1835-1837
- ISSN
- 0007-1447 (ISSN-L)
- 1468-5833
- OpenAlex
- W1966244740
- Cited by
- 123
- References
- 9
- Citations by year
- 2026: 2 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 1 · 2018: 4 · 2017: 4 · 2015: 2 · 2014: 4 · 2013: 2 · 2012: 2
- FWCI
- 10.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- etomidate, adrenal suppression, polytrauma, critically ill patients, cortisol, ACTH, pituitary-adrenal axis, adrenal insufficiency, adverse drug reactions
- MeSH terms
- Adolescent, Adrenal Cortex Function Tests, Adrenal Insufficiency, Adrenocorticotropic Hormone, Adult, Aged, Etomidate, Humans, Hydrocortisone, Imidazoles, Middle Aged, Prospective Studies, Retrospective Studies, Wounds and Injuries
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